Abstract
Ruptured Penetrating Ulcer and aortic arch pseudo-aneurysm is a rare condition but one which carries a high risk of rupture. We report the case of a 74-year-old man with aortic arch pseudo-aneurysm, in which a Frozen Elephant Trunk procedure was successfully performed. There were no postoperative complications at 6 months follow-up. The Computed Tomography Angiogram demonstrated thrombus formation in the pseudo-aneurysm lumen, with no endoleak on the stented part of the descending thoracic aorta and complete patency of all branches of aortic arch. This case demonstrates that the Frozen Elephant Trunk technique may be the treatment of choice when treating such complex aortic arch lesions provided there is no absolute contraindication to radical surgical intervention. However, long-term clinical efficacy and safety have yet to be confirmed.
Highlights
Ruptured penetrating aortic ulcer (PAU) with psendoaneurysm formation is considered an acute aortic syndrome, a dissection variant, which requires emergency attention
We report the surgical treatment of a patient with a ruptured PAU in the aortic arch using the frozen elephant trunk (FET) technique
Case presentation A 74-year-old man with hypertension and Chronic obstructive pulmonary disease (COPD) was emergently admitted with back pain and syncope due to a large 6.2 cm pseudo-aneurysm of the aortic arch originating from a PAU
Summary
Ruptured penetrating aortic ulcer (PAU) with psendoaneurysm formation is considered an acute aortic syndrome, a dissection variant, which requires emergency attention. After systemic heparinization and before incision, a guide-wire was inserted through the right femoral artery in the descending thoracic aorta under fluoroscopic and TEE control. The ascending aorta, proximal aortic arch and innominate artery were dissected and exposed without dividing the innominate vein. The hybrid stent-graft system (33 × 160 mm, E-vita open plus, Jotec Inc., Hechingen, Germany) was introduced antegradely through the open arch in the descending aorta over the stiff guide-wire and released with a pull-back system. The 2nd (8 mm) and 1st (10 mm) branches of the arch prosthesis were connected to the LCCA and IA, and after de-airing systemic circulation to the brain was restored, while SACP from the right axillary artery was stopped (Figure 2b). A CTA scan was performed at 6 months after surgery (Figure 2a and c)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
